Insurance benefits were part of my employment, and I am still paying out of pocket for this insurance, but I am so very very frustrated that they are denying me OT/PT services, home health skilled nursing, social worker. I wondered if complaining to the state board of insurance would do any good. Any help would be appreciated.
2006-12-27 02:48:11 · 5 answers · asked by ladybug 1 in Business & Finance ➔ Insurance
Sure you can! Anyone can complain about any thing. Then they'll forward the complaint to the insurance company, who will say, "no, that's not covered" or "yes, it's covered but we aren't paying because".
Hopefully, you've already gotten some claim denial notices, so you should have some idea about why they aren't paying.
Usually health insurance DOES cover OT/PT services, but NOT home health care, skilled nursing (except inpatient in a hospital) or social worker.
If you have long term care insurance, that may pay for home health care or skilled nursing in your home.
If it's not covered, the insurance department can't rewrite the policy to make it covered. But if it is, and they're just being obstinate, they CAN get something done about it.
2006-12-27 07:17:16 · answer #1 · answered by Anonymous 7 · 0⤊ 0⤋
Complaining won't do you any good. It never has and it never will. You could call the Texas insurance commission and find out if your insurance company is breaking any laws by denying you these things. You may find out some very interesting facts about insurance that way because the insurance commission is just there to help you in case insurance companies try to screw you. You will find their phone number in the state listings in your phone book. Good luck!
2006-12-27 02:57:57 · answer #2 · answered by freakyallweeky 5 · 0⤊ 1⤋
If your policy says PT and OT, etc., are covered services, then definitely contact the insurance board. If your policy says they are not covered, then you're out of luck. I would drop my insurance and get on Medicaid.
2006-12-28 07:26:31 · answer #3 · answered by Tina 3 · 0⤊ 0⤋
Check your plan benefits - if they weren't covered to begin with, you can't force your insurance to cover them. If they are a covered benefit, then find out why they're being denied. If you're not using a participating provider, then you have to use one who participates.
If they're being denied for no viable reason, then file a complaint.
2006-12-27 05:52:28 · answer #4 · answered by zippythejessi 7 · 0⤊ 0⤋
Texas Department of Insurance
P.O. Box 149104
Austin Texas 78714-9104
FAX # (512) 475-1771
2006-12-27 04:04:20 · answer #5 · answered by Chillin-it 7 · 0⤊ 0⤋